Provider Demographics
NPI:1427034487
Name:SCITUATE PODIATRY GROUP INC
Entity Type:Organization
Organization Name:SCITUATE PODIATRY GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:COUNT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:781-337-3334
Mailing Address - Street 1:PO BOX 352
Mailing Address - Street 2:
Mailing Address - City:SCITUATE
Mailing Address - State:MA
Mailing Address - Zip Code:02066-0352
Mailing Address - Country:US
Mailing Address - Phone:781-545-9285
Mailing Address - Fax:781-545-9553
Practice Address - Street 1:541 MAIN ST
Practice Address - Street 2:SUITE 105
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190
Practice Address - Country:US
Practice Address - Phone:781-337-3334
Practice Address - Fax:781-331-2197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA001515213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA606371OtherTUFTS
MA0009377OtherNEIGHBORHOOD HEALTH PLAN
MA9781331Medicaid
MACG5531OtherRAILROAD MEDICARE GROUP #
MA0009377OtherNEIGHBORHOOD HEALTH PLAN
MACG5531OtherRAILROAD MEDICARE GROUP #